Luis Felipe Brandao1,2, Humberto Laydner3,4, Oktay Akca3, Riccardo Autorino3,4, Homayoun Zargar3, Shubha De3, Jayram Krishnam3, Patil Pallavi5, Manoj Monga3, Robert J Stein3, Cristina Magi-Galluzzi5, Cassio Andreoni6, Jihad H Kaouk3. 1. Glickman Urological and Kidney Institute, Cleveland Clinic, 9500, Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA. brandao.lf@gmail.com. 2. Department of Urology, Paulista School of Medicine, UNIFESP, Sao Paulo, SP, Brazil. brandao.lf@gmail.com. 3. Glickman Urological and Kidney Institute, Cleveland Clinic, 9500, Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA. 4. Case Western Reserve University School of Medicine, Cleveland, OH, USA. 5. Pathology Department, Cleveland Clinic, Cleveland, OH, USA. 6. Department of Urology, Paulista School of Medicine, UNIFESP, Sao Paulo, SP, Brazil.
Abstract
OBJECTIVE: To evaluate the feasibility and functional outcomes in porcine models of a novel robotic surgical technique for the treatment of complex ureteral injuries and strictures. MATERIALS AND METHODS: Six pigs underwent robotic ureteral reconstruction using a long tabularized peritoneal flap and followed for 6-9 weeks after the surgery. Ureteral flap vascularity, intra-renal pressure, patency of the conduct, endoscopic aspect of the flap, renal function and histopathology were evaluated. RESULTS: All animals successfully underwent ureteral reconstruction using a tubularized peritoneal flap. Median operative time was 223 min (162-360). Flap tubularization suture took 31 min (19-47), and proximal anastomosis took 20 min (15-38). Bladder mobilization with psoas hitch and distal anastomosis took 9 min (7-12) and 23 min (13-46), respectively. On follow-up, significant shrinkage of the ureteral flap in both length and width was observed. Antegrade pyelograms confirmed dilation and tortuosity of the proximal ureter, dilation of the renal pelvis, and major and minor calyxes without any definitive strictures. Microscopically, focal urothelial lining was seen in the neoureter. Creatinine level was significantly higher at the end of the follow-up period (p = 0.003). CONCLUSIONS: Robot-assisted ureteral reconstruction using a tubularized peritoneum flap is technically feasible and reproducible. The flap sustained abundant vascular supply after different intervals of follow-up and the peritoneal mesenchymal cells differentiated into urothelium and myofibroblasts. Further studies are needed to address the issue of functional obstruction to improve long-term renal function outcomes.
OBJECTIVE: To evaluate the feasibility and functional outcomes in porcine models of a novel robotic surgical technique for the treatment of complex ureteral injuries and strictures. MATERIALS AND METHODS: Six pigs underwent robotic ureteral reconstruction using a long tabularized peritoneal flap and followed for 6-9 weeks after the surgery. Ureteral flap vascularity, intra-renal pressure, patency of the conduct, endoscopic aspect of the flap, renal function and histopathology were evaluated. RESULTS: All animals successfully underwent ureteral reconstruction using a tubularized peritoneal flap. Median operative time was 223 min (162-360). Flap tubularization suture took 31 min (19-47), and proximal anastomosis took 20 min (15-38). Bladder mobilization with psoas hitch and distal anastomosis took 9 min (7-12) and 23 min (13-46), respectively. On follow-up, significant shrinkage of the ureteral flap in both length and width was observed. Antegrade pyelograms confirmed dilation and tortuosity of the proximal ureter, dilation of the renal pelvis, and major and minor calyxes without any definitive strictures. Microscopically, focal urothelial lining was seen in the neoureter. Creatinine level was significantly higher at the end of the follow-up period (p = 0.003). CONCLUSIONS: Robot-assisted ureteral reconstruction using a tubularized peritoneum flap is technically feasible and reproducible. The flap sustained abundant vascular supply after different intervals of follow-up and the peritoneal mesenchymal cells differentiated into urothelium and myofibroblasts. Further studies are needed to address the issue of functional obstruction to improve long-term renal function outcomes.
Authors: Rutger M Schols; Toine M Lodewick; Nicole D Bouvy; Gooitzen M van Dam; Cornelis H C Dejong; Laurents P S Stassen Journal: Dis Colon Rectum Date: 2014-03 Impact factor: 4.585
Authors: Ziho Lee; Shailen Sehgal; Elton Llukani; Christopher Reilly; Leo Doumanian; Jack Mydlo; David Inkoo Lee; Daniel Dong-In Eun Journal: Korean J Urol Date: 2013-08-07